Vitamin D deficiency is a risk factor for developing multiple sclerosis, and the MS Society of Canada now says that people affected by the disease should consume up to 4,000 IU per day to decrease the risk or to potentially modify the extent of the disease.
Vitamin D is acquired by exposure to sunlight or through ingestion of vitamin D3 supplements. Small amounts are found in foods like egg yolks, fortified dairy products and oily fish.
Numerous studies have shown an association between low levels of vitamin D in the blood and the risk of getting MS as well as having relapses. One Canadian study has shown that children with low vitamin D levels were more susceptible to developing MS, as are those who’ve had a virus called Epstein-Barr or a genetic predisposition such as a family history of MS.
Canada has one of the highest rates of multiple sclerosis in the world with about 80,000 individuals diagnosed. MS is an autoimmune disease of the central nervous system that attacks myelin, the protective covering of the nerves that helps transmit nerve impulses. MS symptoms include extreme fatigue, lack of coordination, weakness, tingling, impaired sensation, vision problems, bladder problems, cognitive impairment and mood changes.
Studies have shown that MS is generally more common in countries that are less sunny and farther from the equator. Studies have also shown that MS relapses occur more frequently in winter months when vitamin D levels in the blood are lower. Genetic studies have revealed that lower levels of the nutrient are associated with higher risks of being diagnosed with MS.
The new diet and supplementation guidelines are evidence-based, according to the society. After consultations with medical experts, the recommendations have been endorsed by The Canadian Network of Multiple Sclerosis Clinics and The Consortium of Multiple Sclerosis Centers.
Dr. Robert Carruthers, a neurologist in the MS clinic at the University of B.C. Centre for Brain Health, said that the recommendation from the society is sensible. While the recommendation is that individuals with MS — or at risk of MS — consume between 600 and 4,000 IU daily, Carruthers said he advises his patients to take up to 5,000 IU of vitamin D3 per day. (International Units, or IU, is a measurement of the potency, or biological activity of a product.)
“It’s cheap, safe, and has been shown to be helpful.”
Carruthers estimates that less than 10 per cent of patients coming to the UBC clinic for a new diagnosis are taking vitamin D supplements at the time of their first appointments. That suggests that a blanket recommendation like the one issued Wednesday is important, to get the message out more broadly.
“I encourage patients to take anywhere between 2,000 and 5,000 IU per day. We have to acknowledge we don’t exactly know the right dose but in some studies, doses as high as 10,000 units were used without any clear concerns about toxicity,” Carruthers said in an interview, adding that he also advises patients to quit smoking because it can worsen the course of the disease.
“With patients who have early or mild MS, you want those people to do everything possible to maintain that status, through modifiable risk reductions, including vitamin D3 supplementation and not smoking.”
Two ongoing trials will hopefully yield more definitive answers about the role of vitamin D as a treatment for MS. The Efficacy of Vitamin D Supplementation in MS (EVIDIMS) trial is a pilot study looking at the effects of high-dose vitamin D3 supplementation on brain lesions, inflammatory activity, disability progression and quality of life. Another study, the Vitamin D to Ameliorate MS (VIDAMS) trial, is examining the effectiveness of high-dose vitamin D3 in reducing the relapse rate and disease activity in the brain.
A recent study done at UBC by Dr. Helen Tremlett and her team showed that there may be some subtle signs of MS in the five years before people develop the first typically recognized symptoms.
Tremlett found patients eventually diagnosed with MS patients were up to four times more likely to be treated for pain or sleep problems, and 50 per cent more likely to visit a psychiatrist.
The researchers found that fibromyalgia was fairly common in people who were later diagnosed with MS, as was irritable bowel syndrome. Two other conditions with higher rates among those eventually diagnosed with MS were migraine headaches and any mood or anxiety disorder, including depression, anxiety and bipolar disorder.
The study was the biggest to document symptoms before individuals knew they had MS. It is useful for physicians so they can diagnose the disease earlier when disease-modifying drugs could potentially slow down the damage MS can cause to the brain and spinal cord.
The disease is usually confirmed by magnetic resonance imaging (MRI), tests on nerve impulses, or an examination of spinal fluid.
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